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This paper seeks to explore vertical and horizontal leadership and the relationship of the form of leadership to effectiveness in Swedish cross-professional health care teams.

Questionnaire data were collected from a sample of 47 teams and observation data from a sub-sample of 38 teams. Data on leadership were condensed to indices: directive and participative leadership (vertical leadership) and functional influence and self-regulation (horizontal leadership). Effectiveness was estimated using five measures: team climate, self-assessed effectiveness, teamwork organisation, assessments of results from a simulated case conference (case quality) and manager-rated effectiveness.

Positive relationships were found between leadership and effectiveness with one exception: case quality was negatively associated with vertical leadership though positively to functional influence. When controlled for team climate the correlations between self-assessed effectiveness and leadership disappeared. However, it remained between vertical leadership and the assessment of teamwork organisation. The results suggest that hierarchical and horizontal/shared leadership are complementary forms.

The small number of teams together with the problem of causality in this cross-sectional study are the main limitations.

One implication for practice is the need for clarification of how leadership and influence should be distributed from a contingency perspective.

This study takes both horizontal and vertical leadership into account compared with previous studies often focusing on one facet. In addition, cross-professional health care teams with their special characteristics are underrepresented within research on team leadership.